An Unhealthy Mind

April 6, 2007

"It's a no-risk society," Giuliani went on. "If we continue with this idea of collective responsibility, we'll become a society that deteriorates. And it's a battle that has to be fought now."

He offers health care as an example. "Democrats want universal health care, collective responsibility--honestly, it's their version of socialized medicine." Even the recent health care reform in Massachusetts, designed by the Republican governor Mitt Romney, was tainted with collectivity, because it required every citizen to get health insurance.

"I don't like mandates," Giuliani says. "I don't like mandating health care. I don't like it because it erodes what makes health care work in this country--the free market, the profit motive. A mandate takes choice away from people. We've got to let people make choices. We've got to let them take the risk--do they want to be covered? Do they want health insurance? Because ultimately, if they don't, well, then, they may not be taken care of. I suppose that's difficult." He lets the idea sink in, though it seems to bother his audience not at all. "The minute you start mandating, you always end up with more expensive government programs."

Consider the conservative view of health care. Conservatives repeat the mantra that the United States has "the best health care system in the world"--a formulation used endlessly by President Bush. That isn't true by almost any objective measure. The United States devotes a far higher share of its economy to health care than any other country. Yet, according to the most recent World Health Organization study, the United States ranks just 37th in overall health care performance. These massive inefficiencies derive in part from our huge numbers of uninsured. The uninsured end up forgoing treatment until they arrive at the emergency room. Basic preventive care, of the sort universally available in every other advanced country, would avert such disasters--at less cost to the economy and with less suffering and fatality for patients.

The only way to deem the U.S. system the "best" is if you substitute ideological criteria for pragmatic criteria.